MEDICARE: RHETT RAINS, D.D.S., P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5773	OK

General Provider Information

NPI Number	:	1851569230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHETT RAINS, D.D.S., P.C.

Provider Business Mailing Address
First Line	:	2522 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6712
Country	:	US
Telephone Number	:	918-355-1391
Fax Number	:	918-355-4135

Provider Business Practice Location Address
First Line	:	2522 E KENOSHA ST
Second Line	:
City	:	BROKEN ARROW
State	:	OK
Zip	:	74014-6712
Country	:	US
Telephone Number	:	918-355-1391
Fax Number	:	918-355-4135

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RHETT RAINS
Credential	:	D.D.S.
Telephone Number	:	918-355-1391

Provider Enumeration Date	:	02/19/2008
Last Update Date	:	02/19/2008

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